EDGE in Roux-en-Y gastric bypass: How does it compare to laparoscopy-assisted and balloon enteroscopy ERCP: a systematic review and meta-analysis

Abstract

Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a new endoscopic procedure to perform ERCP in Roux-en-y gastric bypass (RYGB) patients. The aim of this study was to conduct a systematic review and meta-analysis to evaluate technical success, clinical success and adverse effects of EDGE and compare it to laparoscopic ERCP (LA-ERCP) and balloon ERCP (BE-ERCP). Patients and methods We conducted a comprehensive search of several databases and conference proceedings including PubMed, EMBASE, Google-Scholar, LILACS, SCOPUS, and Web of Science databases to identify studies reporting on EDGE, LA-ERCP, and BE-ERCP. The primary outcome was to evaluate technical and clinical success of all three procedures and the secondary analysis focused on calculating the pooled rate of all adverse events (AEs), along with the commonly reported AE subtypes. Results Twenty-four studies on 1268 patients were included in our analysis with the majority of the population being males with mean age 53.72 years. Pooled rates of technical and clinical success with EDGE wer 95.5 % and 95.9 %, with LA-ERCP were 95.3 % and 92.9 % and were BE-ERCP were 71.4 % and 58.7 %, respectively. Pooled rates of all AEs with EDGE were 21.9 %, with LA-ERCP 17.4 % and with BE-ERCP 8.4 %. Stent migration was the most common AE with EDGE with 13.3 % followed by bleeding with 6.6 %. Conclusion Our meta-analysis demonstrated that the technical and clinical success of EDGE procedure is better than BE-ERCP and comparable to that of LA-ERCP in RYGB patients. EDGE also has a similar safety profile as compared to LA-ERCP but has higher AE rate as compared to BE-ERCP.

EUS-directed transgastric endoscopic retrograde cholangiopancreatography versus laparoscopic-assisted ERCP versus deep enteroscopy-assisted ERCP for patients with RYGB

“…2. A recent meta-analysis comparing EDGE with E-ERCP and LA-ERCP concluded that the technical and clinical success of EDGE is superior to E-ERCP and comparable to LA-ERCP [13]. Our study provides further comprehensive comparison of outcomes data at a single academic center, thereby allowing gastroenterologists to make educated decisions along with their patients regarding the choice of procedure.…”

ERCP in RYGB-patients: One size fits all?

“…Methodspecific AEs were minimal in this study, but numbers were too low for adequate comparison. The relative safety of E-ERCP suggested by a recent meta-analysis probably still holds true [4].…”

“…Naturally, the three methods are alternatives that need comparative analysis. A recent meta-analysis addressed the issue [4], and concluded that the technical and clinical success of EDGE is better than that of E-ERCP and comparable to that of LA-ERCP, with adverse events (AEs) similar to that of the laparoscopic approach. At the moment, however, available data are all based on retrospective case series, where direct comparisons remain difficult.…”

ERCP in patient with Roux-en-Y gastric bypass and high grade duodenal stricture across dual lumen-apposing metal stents

“…With advanced application of LAMS, we described a novel case of an EUS-directed transgastric ERCP procedure in a patient with RYGB anatomy in conjunction with a benign enteric stricture, which was performed through a dual transluminal conduit comprised of gastrogastrostomy and duodenal LAMS (▶ Video 1). This highly effective approach should be considered in clinical circumstances where balloon enteroscopy-assisted ERCP is technically challenging and when laparoscopy-assisted ERCP is not feasible [2,3].…”